Guide to Understanding the Surgeon General’s Frame work for Mental Health & Wellbeing in the Workplace

The mental health and wellbeing crisis forces policymakers to act

In the U.S., mental illness is one of (if not) the leading causes of sickness absence and long-term work incapacity. The numbers are stark.

Nearly one in five adults in the U.S. live with a mental illness, according to the National Institute of Mental Health. And these elevated rates of mental illness spill over into the wider economy.

The American Psychiatric Association estimated the macroeconomic loss at USD 210.5 billion per year. Just a single, extra poor mental health day every month was associated with a 1.84 per cent drop in per capital real income growth, or USD 53 billion lost in total income every year from 2008 to 2014, according to a separate analysisⁱ.

Productivity loss from absenteeism and presenteeism was one of the key culprits. Employees with unresolved depression experience a 35 per cent reduction in their productivity, according to the American Psychiatric Association. 

COVID turbocharges the mental health and wellbeing crisis

And that was before COVID. The pandemic, as is often mentioned, turbocharged the pre-existing mental health and wellbeing crisis.

How badly? Rates of anxiety, depression, social isolation, job burnout, and insecurity related to food, housing, and income all rose between March 2020 and mid-2022ⁱⁱ. 

Three quarters of workers now report at least one symptom of a mental health condition (anxiety, depression), an increase of 17 percentage points in just two yearsⁱⁱⁱ.

Meanwhile, a staggering 84 per cent of surveyed workers report at least one workplace factor that had a negative impact on their mental health^iv.

As a result, more than four in every five workers now report that they will be looking for workplaces that support mental health in the future^v.

Industry breakdowns are illuminating. The Kaiser Family Foundation found that almost two in three health workers cited pandemic-related worry and stress negatively affecting their mental health^vi. Almost half of health workers reported the pandemic negatively impacted \their physical health, including sleep issues and frequent headaches.

Similarly, the Centers for Disease Control and prevention found that nearly half of public health workers experienced at least one symptom of a mental health condition during the pandemic, including anxiety, PTSD, and depression; one in twelve experienced suicidal thoughts.

Quiet quitting and the Great Resignation

Public healthcare might be ground zero. But all sectors have been impacted by the mental health and wellbeing crisis, as reports of the Great Resignation and quiet quitting attest.

In 2021, 48 million people quit their jobs in the U.S. – easily breaking records for annual quits^vii. 

March 2022 saw another milestone hit. Data came out, showing that 4.5 million workers had quit their jobs.

Nor are U.S. employers the only ones affected. Resignations jumped in the U.K., Australia, and France, as well, according to CNN^viii.

France saw third-quarter 2021 resignations break records dating back to 2007. The Australian Government announced that 1 million workers began new roles in the three months to November 2021 – a rate of job switching almost ten per cent higher than the pre-pandemic average.

What’s happening?

When asked, pay, health benefits, job security, flexible work arrangements, and retirement benefits were cited as the top five reasons employees would move elsewhere, according to Willis Towers Watson’s 2022 Global Benefits Attitudes Survey.

In the new normal of COVID, many job seekers want more remote work options than employers are allowing.

Over a quarter of survey respondents are always or mostly working from home^ix. Another 15 per cent have an equal split between home and the office. Much higher shares, though (36 and 22 per cent, respectively), would prefer remote work.

The reasons cited, here, include less time commuting, lower costs associated with going to the office, and better management of household commitments.

Alongside this need for flexibility is the rise of burnout, too. And again, this phenomenon is global.

The U.K.’s Royal College of Nursing found that 57 per cent of respondents were thinking about leaving their jobs or actively planning to leave. The top reasons given were feeling undervalued and feeling exhausted.

Rapid turnover, of course, should terrify employers. But rampant absenteeism and presenteeism from mental health and wellbeing issues should worry them, as well.

Employers, after all, experience lower productivity and poorer organizational performance. When their employees feel anxious or depressed, the quality, pace, and performance of work tends to decline.

U.S. Surgeon General Workplace Mental Health & Wellbeing Framework

Reacting to these pressures, policymakers are going on the offensive.

In 2022, the U.K. Government issued a call for evidence to inform a new, 10-year cross-government, mental health and wellbeing plan^x.

Also, in 2022, the U.S. Surgeon General released the New Framework for Mental Health & Well-Being in the Workplace, citing evidence about how the link between work and health has become more evident.

The catalyzing effect of the pandemic on the nature of work and the relationship of workers with their jobs also garners prominent mention:

Today, more and more workers are worried about making ends meet, dealing with chronic stress, and struggling to balance the demands of both work and personal lives. The toll on their mental health is growing. The pandemic also sparked a reckoning among many workers who no longer feel that sacrificing their health, family, and communities for work is an acceptable trade-off. Organizations are also increasingly aware of another trade-off: when the mental health of workers suffers, so does workplace productivity, creativity, and retention.

Far from debilitating, though, the impact of the pandemic should serve to employers as an opportunity to rethink the way we work, argues the Surgeon General:

We have the power to make workplaces engines for mental health and well-being. Doing so will require organizations to rethink how they protect workers from harm, foster a sense of connection among workers, show them that they matter, make space for their lives outside work, and support their long-term professional growth.

What will it take?

That’s where the Framework, the cornerstone of the document, comes in. In the Framework, the Surgeon General outlines Five Essentials for Workplace Mental Health and Wellbeing. These Essentials are meant to help employers develop, institutionalize, and update policies, processes, and practices that best support the mental health and wellbeing of all workers.

Significantly, there’s no sector specificity. The Framework “can be adapted across different workplaces with the recognition that some components may be adapted more extensively for organizations with access to greater resources”.

So, what do the Five Essentials comprise of; they consist of the following points:

1. Protection from Harm. Creating the conditions for physical and psychological safety is a critical foundation for ensuring mental health and wellbeing in the workplace. To this end, workplaces can: 
   a. Prioritize workplace physical and psychological safety
   b. Enable adequate rest
   c. Normalize and support focusing on mental health
   d. Operationalize Diversity, Equity, Inclusion, and Accessibility (DEIA) norms, policies, and programs
2. Connection and Community. Fostering positive social interaction and relationships in the workplace supports worker wellbeing. To this end, workplaces can:
   a. Create cultures of inclusion and belonging
   b. Cultivate trusted relationships
   c. Foster collaboration and teamwork
3. Work-Life Harmony. Professional and personal roles can create work and non-work conflicts. To this end, workplaces can:
   a. Provide more autonomy over how work is done
   b. Make schedules as flexible and predictable as possible
   c. Increase access to paid leave
   d. Respect boundaries between work and non-work time
4. Mattering at Work. People want to know that they matter to those around them and that their work matters. Knowing you matter has been shown to lower stress, while feeling like you do not can increase the risk for depression. To this end, workplaces can:
   a. Provide a living wage
   b. Engage workers in workplace decisions
   c. Build a culture of gratitude and recognition
   d. Connect individual work with organizational mission
5. Opportunities for Growth: When organizations create more opportunities for workers to accomplish goals based on their skills and growth, workers become more optimistic about their abilities and more enthusiastic about contributing to the organization. To this end, workplaces can:
   a. Offer quality training, education, and mentoring
   b. Foster clear, equitable pathways for career advancement
   c. Ensure relevant, reciprocal feedback

Applying the Framework

How to apply these Essentials in your workplace? The Surgeon General notes that the Framework “can be viewed as a starting point for organizations in updating and institutionalizing policies, processes, and practices to best support the mental health and well-being of workers”.

The Five Essentials, in particular, “can guide leaders, managers, and supervisors, as well as empower workers, to identify and communicate about priority organizational changes needed”.

Senior leaders and supervisors, though, will have their work cut out for them. Such decision makers, after all, set the organizational culture. They thusly shape “the day-today experiences of workers”. What can they do to be more effective? According to the Framework, effective leaders express compassion, empathy, and generosity. They also communicate openly, often, and clearly, practicing human- and wellness centered leadership by recognizing the connection between individual strengths, growth, and organizational change.

From the best-practice literature, leadership looking to develop mentally healthy workplaces should also consider deputizing wellbeing committees, including representatives
from Safety and HR, to conduct situational analyses of the current state of wellbeing in the workplace.

Measurement tools available to such committees might include data coming from or related to:

• Sickness absence
• Work-related psychological injuries
• Return to work rates
• Exit interviews
• Staff turnover rates
• Audits of existing mental health policies and procedures
• Focus groups of employees
• Surveys of employee engagement
• Audits of existing leadership and management training
• Examinations of the mental health strategies of similar organizations
• External expert advice and best practices from psychologically healthy workplace programs
• Recognition of upcoming organizational change

Gathering and synthesizing that data is only a first step. With the blessing of senior leadership, wellbeing committees must then abstract from the data to identify and implement the appropriate intervention strategies for the workplace.

Organizations shouldn’t simply implement interventions without follow up, though. Committees must review outcomes and adjust intervention strategies along the way.

What might workplace mental health strategies and tangible actions look like? Again, according to the best-practice literature^xi, they might look like the following:

Finally, the Framework presented by the Surgeon General provides a means to build mentally healthy workplaces and systems for accountability. Such systems, as the Framework notes, are critical to sustaining workplace structures and practices that advance rather than harm the health and wellbeing of all workers over the long term.

Employers, however, will have to do more than go through the motions to implement the Framework and/or other best-practice interventions for establishing mentally healthy workplaces. Interventions need senior leadership sponsorship and attention.

For their part, though, employers stand to gain much in return. The mental health and wellbeing crisis, turbocharged by the pandemic, is eating away at the bottom line. Thoughtful interventions, implemented by wellbeing management software for tracking and reporting, can only improve productivity, deepen engagement, and ensure retention. 

Sources

i. Penn State, Science Daily: Poor mental health days may cost the economy billions of dollars. Available at https://www.sciencedaily.com/releases/2018/07/180730120359.htm.

ii. Peters, S. E., Dennerlein, J. T., Wagner, G. R., & Sorensen, G. (2022). Work and worker health in the post-pandemic world: A public health perspective. The Lancet Public Health, 7(2). https://doi.org/10.1016/s2468-2667(21)00259-0

iii. U.S. Department of Health and Human Services: U.S. Surgeon General Releases New Framework for Mental Health & Well-Being in the Workplace. Available at https://www.hhs.gov/about/news/2022/10/20/us-surgeon-general-releases-new-framework-mental-health-well-being-workplace. html#:~:text=76%25%20of%20U.S.%20workers%20in,in%20the%20future.

iv. Kelly Greenwood and Julia Anas, HBR: It’s a New Era for Mental Health at Work. Available at https://hbr.org/2021/10/its-a-new-era-for-mentalhealth-at-work.

v. American Psychological Association: Workers appreciate and seek mental health support in the workplace. Available at https://www.apa.org/pubs/reports/work-well being/2022 mental-health-support#:~:text=A%20majority%20(81%25)%20of,into%20their%20future%20job%20decisions.

vi. https://files.kff.org/attachment/Frontline%20Health%20Care%20Workers_Full%20Report_FINAL.pdf

vii. Greg Iacurci, CNBC: The Great Resignation continues, as 44% oof workers look for a new job. Available at https://www.cnbc.com/2022/03/22/greatresignation-continues-as 44percent-of-workers-seek-a-new-job.html.

viii. Julia Horowitz, CNN: The Great Resignation is taking root around the world. Available at https://www.cnn.com/2022/03/30/economy/greatresignation-uk-australiaeurope/index.html.

ix. Greg Iacurci, CNBC: The Great Resignation continues, as 44% oof workers look for a new job. Available at https://www.cnbc.com/2022/03/22/greatresignation-continues-as44percent-of-workers-seek-a-new-job.html.
x. https://commonslibrary.parliament.uk/research-briefings/cbp-7547/

xi. Ibid.